Orthodontic appliance and method for moving teeth

ABSTRACT

Systems and methods for moving a tooth using a light, continuous force are disclosed. In examples, a bracket has a surface which is mounted to a tooth, and a pair of wings defining a slot having oppositely disposed upper and lower surfaces that converge at an apex. A wire runs through the slot at a distance from the apex. And a tensioning device presses the wire against a surface of the slot, the system is configured so that the wire gradually moves toward the apex of the slot.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority from and the benefit of U.S.Provisional Patent Application Ser. No. 62/670,406, entitled“ORTHODONTIC APPLIANCE AND METHOD FOR MOVING TEETH,” filed May 11, 2018,which is hereby incorporated by reference in its entirety for allpurposes.

FIELD

The disclosure relates generally to orthodontic appliances and methodsof using orthodontic appliances to move teeth. In particular, anorthodontic system is disclosed to facilitate interaction between abracket with a generally triangular slot, an archwire placed within thegenerally triangular slot, and a tensioning device configured to pressthe wire against a surface of the generally triangular slot. Thisinteraction creates a “force module” that gradually, more precisely, andmore consistent with the natural function of the body, moves the apex ofthe generally triangular slot toward the archwire into an effectiveengagement with the bracket.

SUMMARY

One aspect of the present disclosure is related to a braces system formoving a tooth or a plurality of teeth using a continuous force that maybe lighter in magnitude than the strong intermittent forces associatedwith visits to the orthodontist when using conventional edgewise braces.The system comprises a bracket that is configured to be mounted to atooth, and more particularly a plurality of brackets configured to bemounted to a plurality of teeth. The bracket may comprise a pair ofwings that define a slot having oppositely disposed upper and lowersurfaces, the upper and lower surfaces converging at an apex. A wire ispositioned within and runs through the slot and then held in placewithin the slot by a tensioning device. The tensioning device isconfigured to press the wire against a surface of the slot. Initially,the wire is positioned at a desired distance from the apex of the slotand the system is configured so that, over time, the bracket and thetooth upon which the bracket is mounted gradually moves toward the wire.For instance, as the tooth moves in the desired direction, the wire maybe pressed further down the surface of the slot, such as by force fromthe tensioning device, such that the bracket moves toward the wire to adesired position for the tooth. In some embodiments, the bracket may beconfigured and mounted on the tooth so that the wire is positioned inthe apex of the slot when the tooth reaches its desired location,orientation, etc.

In some embodiments, the tensioning device may be attached to thebracket. For instance, in some embodiments, the tensioning device maycomprise an O-ring, a clip, a cap operatively attached to one or moresprings, or a magnetically-operated cap. In some embodiments, thebracket may comprise one or more elements configured for the secureattachment of a tensioning device. For example, in some embodiments, thebracket may comprise a clip-receiving slot into which a first portion ofthe clip may be inserted, such that a second portion of the clip ispositioned within the slot formed by the wings of the bracket. In otherembodiments, the tensioning device may be integrally formed with thebracket.

In some embodiments, the tensioning device may be configured so that theamount of force applied by the tensioning device against the wire may bemanually adjusted. For instance in some embodiments the tensioningdevice may be tuned to provide a desired amount of pressure against thewire. This could be done, for example, either with the clip attached ordetached from the bracket and would not require the removal of thebracket or wire. In other embodiments, the system may be configured sothat a number of different tensioning devices may be attached to thebracket so that one could adjust the amount of pressure against thewire. This pressure could be adjusted by replacement of a firsttensioning device with a second tensioning device, without the need forremoval of the bracket or the wire.

In some embodiments, the apex of the slot and the wire may be configuredso that the wire fits snugly within the apex of the slot, therebyensuring that the pressure placed on the wire is effectively andefficiently transferred to the tooth. For instance, in some embodiments,the upper and lower surfaces of the slot may form a 60-degree angle atthe apex and the wire may have a triangular cross-section containingthree 60-degree internal angles.

In some embodiments, the system may also be configured to be capable ofresponding to an external pressure placed on the tooth, such as from abiting force that may occur when the wearer eats. In particular, thesystem may be configured so that a tooth and its supporting structurescan function normally when a vertical biting pressure is placed on it bysliding first toward the bone along the lower angled surface and slidingback to the original position after the pressure is released. Thissystem reduces the effect of external vertical pressure placed on thetooth to transmit the same or similar forces to adjacent teeth. Forinstance, the tensioning device may act as a sort of shock-absorber,such as by allowing flexing of the wire vertically along the lowerinclined plane when a hard object (e.g., food) comes into verticalcontact with the wire. This reduces pressure on the teeth and bracketsand avoids breakage of the bracket itself, resulting in a lessening ofthe pressure placed on the tooth by the tensioning device from biting.This allows for the tooth to function in a more biological, and thusmore comfortable, manner when chewing food.

Another aspect of the present disclosure is related to a method formoving a tooth, and preferably a method for moving a plurality of teeth,using a continuous force that is lighter in magnitude than the strongintermittent forces associated with visits to the orthodontist whenusing conventional edgewise braces. The method comprises mounting abracket to a tooth, and in many embodiments mounting a plurality ofbrackets to a plurality of teeth, wherein the bracket comprises a slothaving oppositely disposed upper and lower surfaces that converge at anapex. A wire is placed within (and running through) the slot and atensioning device is brought into contact with the wire so as to pressthe wire against a surface of the slot, thereby imparting a force on thetooth. Initially, the wire may be positioned at a distance from the apexof the slot and over time, the apex of the slot (and bracket andassociated tooth) may gradually move toward the wire. For instance, asthe tooth moves in the desired direction, the wire may be pressedfurther down the surface of the slot toward the apex of the slot. Insome embodiments, the method may comprise mounting the bracket on thetooth so that the wire is positioned in the apex of the slot when thetooth reaches its desired location, orientation, etc. By performing thismethod the force placed on a tooth may be localized and substantiallyindependent from the forces placed on adjacent teeth, allowing for ahigher degree of control over the process of moving one or more teeththan is achieved by conventional methods.

In some embodiments, the wire may run substantially straight through theslot, such that the wire is pressed against the upper surface of theslot or the bottom surface of the slot, but not both. In otherembodiments, the wire may be positioned to run angularly through theslot, such that a first portion of the wire is pressed against an uppersurface of the slot and a second portion of the wire is pressed againsta lower surface of the slot. The latter may be useful, for instance,where it is desired to tilt the tooth such as when the tooth isundesirably leaning frontward or backward. Accordingly, the movement andtilting of the tooth may be achieved without a particularized bending ofthe wire. An unavoidable and uncorrectable consequence of conventionalorthodontics is that any deflection of a wire will result in undesirabletooth movement and/or “round-tripping.” In particular, the term“round-tripping” was originally used to describe teeth moving in onedirection and then reversed to gain the final desired position. Inconventional orthodontics, round-tripping occurs when adjacent anchorageteeth unnecessarily adjust their positions due to a wire deflected fromthem to gain desirable movement of an adjacent displaced tooth and thenreturn to their original positions. The presently disclosed systems andmethods are designed such that deflection of the wire is unnecessary formoving teeth, and round-tripping and associated movement is largelyavoided. Thus, the gradual movement from the bracket as the apex isdrawn toward the wire is contrary to the principles that have governedconventional orthodontics.

Another aspect of the present disclosure is related to a system andmethod for independently moving a plurality of teeth using a pluralityof brackets and a single wire. The method comprises mounting a pluralityof brackets on a plurality of teeth, wherein each of the brackets has aslot. A wire is then placed within and running through the slots of eachbracket. At each bracket, a localized force against the wire isprovided, such as through the use of a plurality of independenttensioning devices. Accordingly, each bracket-bearing tooth is providedwith an independent force. For instance, the localized force against thewire at a first bracket may be different from the localized forceagainst the wire at the second bracket, which may cause a first tooth tomove independently from the second tooth. This may be the case evenwhere the first tooth and the second tooth are adjacent.

In some embodiments, the forces independently provided to each tooth maybe controlled by selection and/or adjustment of a particular tensioningdevice. For instance, the localized force against the wire at a firstbracket may be provided by a first tensioning device and the localizedforce against the wire at a second bracket may be provided by a secondtensioning device. The first and second tensioning devices may differ inthe localized forces provided by each, even where the first and secondtensioning devices may be of generally the same type. For instance, eachof the first and second tensioning devices may be clips, but thedistinct clips may each be configured to provide a different degree ofpressure on the wire.

Another aspect of the present disclosure is related to a system andmethod for moving a tooth or a plurality of teeth without causing anytorsional movement to the anchorage teeth, i.e. without impacting theposition or orientation of the anchorage teeth. The method comprisesmounting a bracket on the tooth, or a plurality of brackets on theteeth, wherein the bracket contains a slot. Then, a wire is placedwithin the slot and anchored to at least two anchorage teeth. Alocalized force against the wire is provided, the localized forcepressing the wire against a surface of the bracket to impart a localizedforce on the tooth, such that the force placed on the tooth is nottransferred to the anchorage teeth by the wire as generally occurs withconventional edgewise braces. The specific embodiments of the bracketsand tensioning devices described herein may be used to practice thismethod, although it is contemplated that other embodiments notspecifically described herein may also be used.

Another aspect of the present disclosure is related to a system andmethod of moving one or more teeth into a desired final position using asingle continuous adjustment period, meaning that a wearer will not needto have the wire replaced during movement of the tooth/teeth. The methodcomprises mounting a bracket to a tooth, the bracket comprising a slothaving oppositely disposed upper and lower surfaces that converge at anapex. The method further comprises placing a wire within the slot andbringing a tensioning device into contact with the wire so as to pressthe wire against a surface of the slot. Initially, the wire may bepositioned at a distance from the apex of the slot and over time, theapex of the slot (and bracket and associated tooth) may gradually movetoward the wire. For instance, as the tooth moves in the desireddirection, the wire may be pressed further down the surface of the slottoward the apex of the slot. Because the force provided by the pressingof the wire against bracket by the tensioning device is continuous, thetooth may be moved to a desired final position without the need formanually reconfiguring or replacing the wire, as is typically necessaryusing conventional edgewise braces.

Another aspect of the present disclosure is related to an orthodonticapparatus (commonly referred to as braces) configured to efficiently andeffectively move a tooth or a plurality of teeth without a significantloss of force between the wire and the bracket due to tolerance or“play” of the wire within the slot. For example, conventionalorthodontic appliances with slots that, by necessity of their design,have tolerances or play. The apparatus comprises a bracket that isconfigured to be mounted to a tooth and that includes a pair of wingsdefining a slot having oppositely disposed upper and lower surfaces thatconverge at a triangular apex. The apparatus also comprises a triangularwire configured to run through the slot and a tensioning deviceconfigured to press the wire against a surface of the slot tocontinually and gradually apply a force against the teeth, in contrastto conventional orthodontic appliances. The dimensions of the triangularwire and the dimensions of the triangular apex of the slot may beconfigured so be substantially identical which leads to more accuratepositioning of the teeth. For instance, in some embodiments, the upperand lower surfaces of the slot may form a 60-degree angle at the apexand the wire may have a triangular cross-section containing three60-degree internal angles.

Another aspect of the present disclosure is related to a system formoving a first tooth in a patient's mouth that includes a bracket havinga surface configured to be mounted to a first tooth and a pair of wingsdefining a slot having oppositely disposed first and second surfacesthat converge at an apex. A wire runs through the slot at a distancefrom the apex, and a tensioning device provides a force pressing thefirst surface of the slot toward the wire. The system is configured sothat the tensioning device gradually moves the apex of the slot towardthe wire. In some embodiments, the tensioning device is attached to thebracket.

In some embodiments, the tensioning device comprises an O-ring, a clip,a cap operatively attached to one or more springs, or amagnetically-operated cap. In some embodiments, the bracket comprises aclip-receiving slot and the clip is inserted into the clip-receivingslot to attach the clip to the bracket. In some embodiments, the one ormore springs are positioned in the cap, in the bracket, or both. In someembodiments, the magnitude, direction, or both of the force pressing thefirst surface of the slot toward the wire is adjustable. In someembodiments, the first and second surfaces of the slot form a 55 to65-degree angle at the apex. In some embodiments, the wire is atriangular wire configured to fit in the apex.

In some embodiments, the system is configured so that the system iscapable of responding to an external pressure placed on the first toothby changing the magnitude, direction, or both of the force pressing thefirst surface of the slot toward the wire. In some embodiments, suchthat an external pressure placed on the first tooth having a certainmagnitude and direction reduces the magnitude of the force pressing thefirst surface of the slot toward the wire.

Another aspect of the present disclosure is related to a method formoving a first tooth in a patient's mouth. The method includes mountinga bracket to the first tooth, the bracket comprising a slot havingoppositely disposed first and second surfaces that converge at an apex,placing a wire within the slot, and bringing a tensioning device intocontact with the wire so as to provide a force pressing the firstsurface of the slot toward the wire at a distance from the apex, therebyimparting a force on the first tooth. The tensioning device isconfigured to gradually move the apex of the slot toward the wire.

In some embodiments, the magnitude, direction, or both of the force onthe first tooth is independent from the forces placed on adjacent teeth.In some embodiments, the wire is positioned within the slot so that thetensioning device presses a first portion of the wire against the firstsurface of the slot and a second portion of the wire against the secondsurface of the slot. In some embodiments, the tensioning devicecomprises an O-ring, a clip, a cap operatively attached to one or moresprings, a magnetically-operated cap, or a combination thereof.

In some embodiments, the bracket comprises a clip-receiving slot and theclip is inserted into the clip-receiving slot to attach the clip to thebracket. In some embodiments, the one or more springs are positioned inthe cap, in the bracket, or both. In some embodiments, furthercomprising adjusting the amount of force by which the tensioning devicepresses the first surface of the slot toward the wire. In someembodiments, adjusting the amount of force by which the tensioningdevice presses the first surface of the slot toward the wire comprisestuning the tensioning device.

In some embodiments, adjusting the magnitude, direction, or both of theforce by which the tensioning device presses the first surface of theslot toward the wire comprises replacing a first tensioning device witha second tensioning device. In some embodiments, the magnitude of theforce imparted on the first surface of the slot toward the wire isreduced in response to an external pressure placed on the first tooth.In some embodiments, the tensioning device temporarily moves the apex ofthe slot away from the wire in response to an external pressure placedon the first tooth.

Another aspect of the present disclosure is related to a method formoving a first tooth in a patient's mouth. The method includes mountinga first bracket on a first tooth and a second bracket on a second tooth,the first bracket comprising a first slot defining a first surface andthe second bracket comprising a second slot defining a second surface,placing a wire first and second surfaces, providing a first localizedforce between the wire and the first surface, and providing a secondlocalized force between the wire and the second surface, in which thesecond force is the same as or different from the first force, therebyimparting an independent force on each of the first and second teeth.

In some embodiments, the first localized force is provided by atensioning device attached to the bracket. In some embodiments, in whichthe first localized force and the second localized force are differentin magnitude. In some embodiments, the first localized force is providedby a first tensioning device and the second localized force is providedby a second tensioning device. In some embodiments, each of the firstand the second tensioning devices comprises a clip attached to theassociated bracket. In some embodiments, in which the first tensioningdevice is different from the second tensioning device.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure includes a number of drawings and supporting description,which are provided for the purpose of illustrating and clarifying somenon-limiting aspects and embodiments of the disclosure. The drawingsshould not be viewed as limiting the spirit or scope of the invention.

FIG. 1 is a perspective view of an orthodontic system according to anembodiment of the present disclosure, showing the wire runningsubstantially straight through the slot (and held in contact with theupper surface of the slot by a clip).

FIGS. 2 and 3 are side elevation views of the orthodontic system of FIG.1, showing progression of the bracket 16 toward the wire 14, accordingto an embodiment of the present application.

FIGS. 4 and 5 are schematic detail views similar to FIGS. 2 and 3,showing a mechanism of relative movement of a bracket and a wire withina disclosed system, according to an embodiment of the presentapplication.

FIG. 6 is a perspective view of another orthodontic system, according toan embodiment of the present disclosure.

FIG. 7 is a schematic elevation view of an application of a conventionalorthodontic system on several teeth.

FIG. 8 is a schematic elevation view of an application of the presentlydisclosed orthodontic system on several teeth.

FIGS. 9 and 10 are two detail views of a bracket of FIG. 8, showingspacing detail of the presently disclosed orthodontic system of FIG. 8.

FIGS. 11 and 12 are side elevation views showing an application of thepresently disclosed orthodontic system on several teeth to effectstraightening of the third and fourth illustrated teeth.

FIG. 13 is a perspective view showing a disclosed system illustrating adouble helical loop design (e.g., with flexible Nickel-titanium plates)that can slide into a convex-configured slot, according to an embodimentof the present application.

FIGS. 14 and 15 are side elevation views, with underlying parts shown indashed lines, showing a nickel-titanium wire clip engaging a bracket anda wire, interchangeable with any of the above, according to anembodiment of the present application.

FIG. 16 is a view similar to FIG. 14, but showing a magneticpillow-style clip engaging a bracket and a wire, interchangeable withany of the above, according to an embodiment of the present application.

FIG. 17 is an isolated front elevation view, with underlying parts shownin dashed lines, of the magnetic pillow-style clip of FIG. 16.

FIG. 18 shows the system of FIG. 16 with the magnetic pillow-style clipforcing the wire and apex together, according to an embodiment of thepresent application.

FIG. 19 is a view similar to FIG. 17 of the magnetic pillow-style clipof claim 18, according to an embodiment of the present application.

FIG. 20 is a front elevation view of an alternative bracket with helicalsprings in the base, according to an embodiment of the presentapplication.

FIG. 21 is a section taken along section lines 21-21 of FIG. 20.

FIG. 22 is a bottom plan view of the bracket of FIG. 20, showing thewire and apex advanced together.

FIG. 23 is a view similar to FIG. 21, showing the wire and apex advancedtogether.

FIGS. 24-26 are views similar to FIGS. 20, 21, and 23, showing adisclosed system with a compression spring inside a hinged cap-styleclip, according to an embodiment of the present application.

FIGS. 27 and 28 are perspective views showing a disclosed system withhelical compression springs inside bracket wings with horizontal bars,according to an embodiment of the present application.

FIG. 29 is a perspective view of a disclosed system illustrating asingle (per side) helical spring clip design with a T-bar clip,according to an embodiment of the present application.

FIG. 30 is a perspective view of a disclosed system illustrating adouble (per side) helical spring clip design, according to an embodimentof the present application.

FIGS. 31 and 32 are a perspective view and a side elevation of adisclosed system illustrating helical springs embedded in the base ofthe bracket with an interconnecting bar, according to an embodiment ofthe present application.

FIGS. 33-35 are a perspective, a rear elevation, and a side elevationview, with dashed lines showing movement or underlying parts, of alingual system with a first style of self-ligation, according to anembodiment of the present application.

FIGS. 36-39 respectively show a top plan view, two rear elevationsshowing movement, and a side elevation view of the structure of FIG. 37,showing a lingual system with a second style of self-ligation, accordingto an embodiment of the present application.

FIGS. 40 and 41 are views similar to FIGS. 37 and 38 of anotherembodiment of a lingual system, according to an embodiment of thepresent invention.

FIGS. 42 and 43 are plan views, respectively open and closed, showing aplier for making adjustments to a triangular archwire, according to anembodiment of the present application.

FIG. 44 is an exploded perspective view, FIG. 45 is a perspectiveassembly view, and FIG. 46 is a side elevation view showing a molar tubedesign with a C-clip to insure accurate labio-lingual positioning of thewire in the apex of the slot. This design can also be utilized forimproved accuracy with the conventional appliances by using arectangular slot instead of the triangular slot, according to anembodiment of the present application.

The foregoing summary, as well as the following detailed description ofcertain embodiments of the present application, will be betterunderstood when read in conjunction with the appended drawings. For thepurposes of illustration, certain embodiments are shown in the drawings.It should be understood, however, that the claims are not limited to thearrangements and instrumentality shown in the attached drawings.Furthermore, the appearance shown in the drawings is one of manyornamental configurations that can be employed to achieve the statedfunctions of the system.

The following is a list of the reference characters used in thisspecification and the parts they identify:

10 orthodontic appliance  21 section lines 150 base 12 bracket  98region of the 152 clip 14 wire base 154 springs 16 wings 100 springs 156posts 18 slot 102 clip 158 slots 20 clip 104 base 160 hook 22 base 106slot 162 system illustrating 24 horizontal auxiliary 108 fastenershelical springs slot 110 clip 164 interconnecting 26 tube 112 spring bar28 tooth 114 hinge 166 clip 30 apex 116 pin 168 clip 32 portions 118latch 170 bracket 34 portion 120 clip 172 pin 36 arrow 122 opening 174slot 40 orthodontic system 124 bars 176 barrier 42 bracket 126 tool 192spacers 44 tab 128 manipulator 194 protractor - style 46 perforations130 bracket wings markings 48 wing 132 channels 200 molar tube design 60system 134 surface 202 additional round 62 plate 136 springs tubes 64clip 140 clip 204 slope 66 wings 142 spring 206 breakaway tab 68 slope144 posts 208 bracket 70 base 146 hook 210 auxiliary slot 72 convex -configured 148 void 212 C - type clip slot

DETAILED DESCRIPTION

Generally speaking, this application discloses an orthodontic system tofacilitate interaction between a bracket with a triangular slotoptionally having a 60-degree angle at its apex, a wire, optionally anequilateral triangular or round wire, and a tensioning device configuredand arranged to create a localized tension between the wire and asurface of the slot. The bracket is secured to a tooth of an orthodonticpatient. This interaction creates a force module that gradually, moreaccurately and more consistent with the natural function of the body,moves the wire and bracket toward one another into a full and totalengagement, thus moving the tooth secured to the bracket into or towardits intended position at the conclusion of orthodontic treatment.

The specialty of orthodontics has a multitude of different approachesfor moving teeth, and all have tried to fulfill the goals of an idealorthodontic appliance; namely, the capability of moving any tooth in anyplane of space, individually or in groups, in either dental arch, whileexerting differential, more natural, non-destructive forces on thedentition. Edward Angle, in 1928, was the first to address the goal ofcontrol in all planes with his “Edgewise Appliance.” Despite nearlyninety years of orthodontic innovations and advances in diagnostic andtreatment modalities, the basic design, application and philosophy oftreatment with the conventional edgewise appliance remains virtuallyunchanged, and the other stated goals have not been adequately met.

The reason for these goals having gone unfulfilled stems from thelimitations of the conventional designs. This conventional appliancerelies on the full engagement of a round or rectangular wire in adeflected state to move teeth. Unfortunately, there are a number ofproblems associated with this appliance. The first is that fullengagement of the wire creates the highest level of force upon insertionof the wire. This high level of force is associated with pain anddiscomfort to the patient as well as an increased potential for rootresorption and undermining resorption of the bone.

While orthodontic research has documented that light, continuous forcesare what move the teeth in the least deleterious fashion, the onlyimprovement that has helped the conventional edgewise appliance movetoward that goal has been a metallurgical improvement in the archwires.Nickel-titanium archwires have given greater range and memory to thewires, but the mechanism of movement is still the same.

A second significant disadvantage of the conventional edgewise applianceis that while torsional movement can occur with the use of a rectangularwire twisted along its long axis, only small movements will occur in oneadjustment period, and adjacent teeth are used as anchorage to allow theprogrammed change. Unfortunately and unavoidably, these adjacent teethused for anchorage in order to move the desired tooth will themselvesmove due to the twisting of the wire to engage the tooth being moved.

A third major disadvantage of the conventional edgewise appliance isthat whatever amount of torsional movement is placed in the archwire,that amount of torsion will never be delivered to the teeth. By virtueof the design, no wire, be it round or rectangular, will fit the slotwithout play or tolerance. Depending on the cross-sectional size of thearchwire, the amount of “play” can be as much as 7 degrees for each0.001-inch increment difference between the height of the slot and thevertical thickness of the wire placed in the slot. Since manufacturingtolerances allow for significant differences in the slot size, theunpredictability becomes even worse.

In contrast, the presently disclosed system, an example of which isshown in FIG. 1, can be described as comprising a sliding inclined planebetween a pair of bracket wings upon which the wire interacts, providingsignificant improvements in each of these three major points. Thepresently disclosed system also offers many additional advantages thatare described in greater detail below with reference to the orthodonticappliance and methods disclosed herein. For example, the disclosedsystem does not require full engagement of the archwire to effectdesired positioning of the teeth, thereby creating a more desirable andbiologically compatible movement of the teeth.

In another example, since tooth movement in the disclosed system iscontrolled by the bracket/wire/tensioning device interface (hereafterreferred to as an independent “force module”), not the deflective forceof the archwire seen in conventional systems, each tooth movesindependently, thereby eliminating the unwanted movement of adjacentteeth, especially in torsional control. Clinically, this reduction ofunwanted movement is highly desirable. In some disclosed embodiments,the amount of movement of the teeth, especially in torsional movement,will be exactly what is programmed. In some embodiments, the movement ofthe teeth will also be significantly more than what would have occurredin the conventional systems, such as the conventional edgewise system.This may occur, for instance, because the 60-degree internal angle of anequilateral triangle will fit exactly without play into the 60-degreeangle of the bracket placed on each tooth.

To date, all fixed orthodontic appliances have relied on the attachmentof a wire that deflects from its passive configuration to engage withina rectangular slot incorporated within a bracket bonded or banded to oneor more teeth for the purpose of moving said teeth to a new positiondictated by the passive position of the wire. For any of theseorthodontic appliances to work effectively, with control in one, two orthree dimensions, a round or rectangular wire must be fully engagedwithin the bracket slot, with the maximum force of deflection occurringas soon as the wire is engaged, and dissipating as the tooth is moved tothe passive position of the wire.

The process of moving teeth in this fashion means that the greatestamount of force placed on the teeth, and the subsequent pain produced,occurs immediately following the engagement of the archwire. Thisso-called “cycle of pain” is well known to millions of orthodonticpatients since 1928 when the Edgewise Appliance was introduced andbecame the basis for nearly every fixed orthodontic appliance currentlyin use.

The disclosed appliance and method of moving teeth does not rely on thefull engagement of the deflected wire within a slot to effect movement.In fact, it does not rely on the flexibility of the wire at all.Instead, the disclosed system facilitates interaction between atriangular slot having non-parallel sides, a wire that serves as aguide, and a tensioning device configured and positioned to place alocalized force on the wire within the slot. The disclosed combinationof components creates a force module that will gradually, moreaccurately and more physiologically move the wire and bracket into afull and total engagement. Instead of heavy, intermittent forces beingplaced on teeth and dependent on the physical properties of the wires,the disclosed system results in lighter, continuous forces that can becontrolled by a tensioning device such as a self-ligating clip (see,e.g., the several figures for multiple included configurations),elastomeric O-rings, and/or other forms of gentle, continuous force.

The appliance includes individual attachments fixed to each tooth to becontrolled, either all or any number less than all the teeth, by guidewires that will connect all teeth to be controlled, and a form ofconnection between the individual attachment and the guide wire. Fromthis point forward, the individual attachments will be called bracketsand/or tubes, which may vary in configuration according to the type oftooth to which the attachment is connected. These brackets can either bebonded with an appropriate adhesive directly to the tooth, or attachedto a flat stainless steel ring that fits the circumference of the toothand is cemented with an appropriate cementing medium. The guide wireswill be referred to as wires or archwires. These archwires are shapedaccording to the desired archform of each anatomical configuration ofthe maxillary and mandibular group of teeth. The form of connectionbetween the brackets and the archwire will be referred to as tensioningdevice clips or O-rings, which supplies the force necessary to bring thewire gradually and tightly into the apex of the bracket slot.

FIG. 1 is a perspective view of an orthodontic appliance 10 with abracket 12 that may include a pair of bracket wings 16 on oppositeedges. Thus, the attachment or ligating wings 16 define a divergingplane slot 18, optionally with a 60-degree angle at an apex 30, andoptionally with trumpeted edges at the external edges of the slot 18 toincrease the opening of the slot 18 to make it easier for the slot 18 toreceive the archwire 14. As shown, the wire 14 (e.g., archwire,guidewire) runs substantially straight through the slot 18 and is heldin contact with a surface of the slot 18 by a tensioning device 20, suchas a clip. The bracket 12 has a base 22 that is fixed to a tooth 28,such as by an adhesive. Optionally, a tube 26 can be included forattachment of auxiliary appliances, such as elastics or coil springs.

The bracket 12 may be formed of a rigid material such as, but notlimited to, stainless steel, ceramic, acrylic, composite, Food and DrugAdministration (FDA) approved resins, and/or titanium materials. In someembodiments, the bracket 12 may also comprise a vertical slot in thebase 22 to accommodate the attachment of a tensioning device, such as aclip that may slide vertically between the laterally placed wings 16 ofthe bracket 12. In some embodiments, the bracket 12 may also comprise ahorizontal auxiliary slot 24 for auxiliary attachments as needed foradditional torsional or rotational movements. Although shownsubstantially straight, in FIG. 1, in some examples the wire 14 extendsthrough the slot 18 at an angle.

In the case of tubes, there may be additional round tubes 202 on FIGS.44, 45, 46 for attachment of auxiliaries, such as headgear, expansionwires, Herbst appliances or other yet to be developed auxiliaries.

FIGS. 2 and 3 illustrate a side view of the orthodontic system 10 ofFIG. 1. As shown, the diverging planes that define slot 18 may have twoportions 32 and 34 defined by different angles. In this example,opposing portions 32 meet at the apex 30 with an approximate 60-degreeangle, whereas the angle associated with portion 34 is more obtuse. Thisallows for a wider opening into which to place the wire 14, as well asencouraging a lighter force profile when wire 14 is in contact with asurface of portion 34 versus portion 32. Although FIGS. 1-5 are shownwith two different angles along slope 18, the angle could have a flatsurface of a single, constant angle (e.g., 60-degree angle). In otherexamples, the apex 30 can open with an ever-changing gradient to the tipof wings 16, or other suitable variation on the slope to aid in urgingthe wire 14 to the apex 30 in a consistent, gradual manner.

Further, FIG. 2 shows the wire 14 removed from the apex 30. For example,tooth 28 may be in an undesirable position, and the wire 14 is placedinto the slot 18 such that contact is made with the surface of a wing16. Clip 20 applies a force against the wire 14 to urge the apex 30, andtherefore the bracket 12 and associated tooth 28, toward the wire 14. Asshown in FIG. 3, the combination of forces (i.e. the “force module”)urges the tooth 28 into alignment with the wire 14 to a desiredposition, as determined by the wire 14, shown by arrow 36.

The system 10 shown in FIGS. 1-3 illustrate how the various componentscooperate to provide light, continuous forces which are self-limitingand constant as the wire's leading edge moves toward the apex of theslot. In particular, the force generated by the appliance is dependenton and limited to the force generated by the force module. Therefore,force levels for individual modules can be customized using differentclips or by individually adjusting/tuning the clips. In some examples,the force applied on the wire from the clips moves the bracket towardthe wire into the desired position.

FIGS. 4 and 5 show a mechanism of movement of a wire within a disclosedsystem, as described herein. Thus, the wires slide against a surface ofa wing to urge movement of the tooth to align with the archwire (e.g.,such as by application of force from a tensioning device, clip, etc.).The archwires may be formed of any material that will allow thepractitioner to create an archform appropriate for the alignment of theteeth. Examples include, but are not limited to stainless steel,cobalt-chrome, nickel-titanium, Australian, fiber reinforced composite,composite, FDA approved resins, heat activated nitinol, coppernickel-titanium, or any other material suitable for forming a wire orother guiding device. Embodiments of the wires may be configured in twodistinct cross-sectional shapes: round; or equilateral triangular withthree 60-degree internal angles. A wire having an equilateral trianglecross-sectional shape functions in a manner that differs from that ofother cross-sectional shape of wire conventionally used in orthodontics,as is described herein.

The unique design of the presently disclosed orthodontic system allowsfor precise control of tooth movement, in contrast to other fixedorthodontic appliances. For example, in the disclosed orthodontic systemherein, there is no tolerance between the wire and the bracket slot whenthe two are fully seated at the apex of the slot. Inherent in anyconventional edgewise design is the difference in the height of the wireversus the height of the slot. An example of the imprecision inconventional designs is as follows: for every thousandth of an inchdifference between the wire's height dimension and the height of thebracket slot, there is a 7-degree difference in the amount of torsionalmovement that actually can occur from what was programmed into the wire.This challenge is overcome in embodiments of the disclosed system.

FIG. 6 is a perspective view of another orthodontic system 40 with thewire 14 running substantially straight through the slot and held incontact with a surface of wing 48 by a clip 20. In this example, bracket42 includes a breakaway tab 44. The tab 44 may include perforations 46,or may be otherwise manipulable (such as with a cutting tool, etc.) toallow for easy removal.

FIG. 7 shows an application of a conventional orthodontic system onseveral teeth. As shown, the channel through which the wire engages withthe bracket is necessarily narrow, as movement on the teeth is affectedby full engagement between the bracket and the wire. The more a wiremust deflect into a slot, the more undesirable movement that will occur.For instance, in a conventional appliance employing a rectangularchannel, the wire may be sized substantially similar to the channel inorder to make the required amount of contact to cause the rotationaland/or torsional movement to adjust the tooth. Even in conventionalsystems with different geometric channels with different geometries(i.e. triangular), the channel requires full engagement between thebracket and the wire, causing a full force against the tooth. This fullengagement also causes unnecessary forces acting on adjacent teeth, as atight tolerance is needed between the wire and the bracket channel togenerate movement in a tooth, such that the bend in the wire betweenbrackets is sharp. This can cause the effected teeth to misalign,resulting in further discomfort and/or additional treatments tocompensate for unnecessary movement.

By contrast, FIG. 8 shows an application of the presently disclosedorthodontic system on several teeth. As shown, the present systembenefits from the maximum occluso-gingival dimension of the opening ofthe slot (e.g., a 60-degree slot, or a slot of substantially similarangles such as a 50-70-degree slot) which is directly proportional tothe depth of the slot, and the distance between the mesial and distalbracket wings, resulting in a synergistic anchorage arrangement acrossthe six teeth. Unlike the conventional edgewise appliance using arectangular slot (e.g., typically either a 0.018 or 0.022 inch wideslot), the slot in the presently disclosed system can be varied bychanging the depth of the slot in order to increase the range by whichthe archwire can actively engage within the wings of the slot withoutdeflection of the wire. This range may be two to three times wider thanthe dimensions possible with the conventional edgewise bracket, whereteeth that are farther away from their ideal position will still havetheir brackets engage the archwire without needing the deflection of thearchwire. In some examples, the angle of each slot can also be modified,as well as the width of the brackets and/or the distance between eachbracket.

FIGS. 9 and 10 show spacing detail from of the presently disclosedorthodontic system of FIG. 8. For instance, another dimension thatdetermines the range of engagement between the bracket and the wire isthe distance between the mesial and distal wings of the bracket. Forexample, the wider the distance, the smaller the effective range ofengagement. Conversely, the narrower the distance between the bracketwings, the greater the effective range of engagement.

For instance, for an orthodontic bracket to be effective, it needs toprovide the ability to move a tooth in all three planes ofspace-vertical, horizontal or rotational, and torsional. Traditionally,conventional brackets have had inherent limitations in the effectivenessof movement in one of the planes of space because the appliance isdependent on the range of deflection of the archwires since the wireshave to be fully engaged in the slot to work. Increasing vertical rangeof movement by narrowing the bracket increases inter-bracket distancegiving the wire more room to bend between brackets but reduces theeffectiveness of the rotational control and vice versa. Increasing thewidth of the bracket allows for very effective rotation, but reduces therange of torsional movement as well as vertical movement since theinter-bracket distance decreases and reduces the ability of the wire todeflect. In other words, orthodontists have, for decades, had to livewith some form of compromise in the width of the brackets because therewas no ideal bracket size or design that maximized movement in all threeplanes.

In the presently disclosed system, since the wire does not require anydeflection to engage the bracket due to the large range of engagementand exclusive independent mechanism of movement, the inter-bracketdistance can be minimal, the width of the bracket maximal androtational-horizontal control, as well as vertical and torsionalmovement maximized. Compromise is no longer necessary with the presentlydisclosed orthodontic system.

The inter-wing distance can also influence the range of engagement,increasing the range of engagement by decreasing the inter-wingdistance. This might, in some instances, be advantageous, and there willbe a range of bracket widths and labial surface radiuses that anorthodontist will be able to choose from to semi-customize eachindividual case.

The slot is preferably 60-degrees, with the depth of the slot at leasttwice the height of the largest equilateral triangular wire. Triangularwires are equilateral for improved torsional force control and theproperties of this cross-sectional configuration more closely mimicthose of round torsion bars than any other configuration. Since roundwires are not effective for torsional movement of teeth without aperpendicular arm welded or soldered to it, a suitable alternative to around wire for torsional adjustment is an equilateral triangle, ratherthan rectangular or square wires used in the conventional edgewiseappliance. The design of the body of the bracket will be dependent onthe design of the various clips that have been created for the system.The curvature of the slot will be dependent on the mesio-distal (width)curvature of the tooth the bracket will be placed on, and consistentwith the overall arch form.

Due to the increased accuracy of the appliance in each plane ofmovement, the device is suited for customization based upon3-dimensional imaging and computerized tooth set-ups. Once an idealtooth set-up is established, customized brackets can be constructed withbuilt-in first and third order adjustments (e.g., labio-lingual,torsion), as well as tip or second order adjustments. This increasesconformity and accuracy, and decreases treatment time and pain to thepatient.

FIGS. 11 and 12 show an application of the presently disclosedorthodontic system on several teeth. FIG. 11 shows the degree from anideal vertical in six mandibular anterior teeth (i.e. cuspid to cuspid).Since the bracket/clip force module flexes to accommodate the wire, theclip will deflect while the archwire maintains a passive, consistenttorque. For example, there will be little or no torsional movementwithin the wire, even for teeth with 30 degrees of lingual crown torque(e.g., teeth 3 and 4). Instead, the clip will deflect, placing force onthe wire to eventually engage fully within the triangular slot.

Since the archwire and bracket slot will continue to interact to forcethe apex to the wire due to the force from the clip, this movement willbe continuous and gradual, and does not initially require the fullengagement of the wire in the slot as is required in conventionalsystems.

However, since full engagement will eventually occur, the torqueprogrammed into the system is the torque ultimately experienced by theteeth, shown in FIG. 12, as each tooth moves separately from another. Bycontrast, the conventional edgewise system requires full engagement ofthe archwire within the slot. This requirement ensures that the greatestamount of force experienced on the tooth is upon insertion of the wire.The high level of force is associated with pain and discomfort to thepatient as well as an increased potential for root resorption andundermining resorption of the bone. In addition, the torsional readingsof the six teeth will be well short of 0 degrees (i.e. 0, 4, 8, 8, 4 0)and will require torsional overcompensation to eventually reach thedesired torque.

FIG. 13 shows a system 60 illustrating a double helical loop designplate 62 (e.g., with flexible Nickel-titanium) that can slide into aconvex-configured slot 72. Although illustrated as a double helical loopdesign, the plate 62 may have a single loop or other type of bentconfiguration, depending on the desired amount of tension, sizeconstraints, etc. The plate 62 may be hinged to a clip 64 that can forcethe wire 14 toward a base 70. As shown, wings 66 are defined by a slope68 with a consistent angle toward an apex. However, in other examples,the slope may have multiple angles, a sloped grade, or other suitableshape, consistent with this disclosure.

Tensioning devices, which in some embodiments may be O-rings or clips,apply the forces that create the movement, unlike every otherconventional orthodontic appliance. O-rings may be formed from anelastomeric material suitable for attachment to the bracket by way ofthe bracket's attachment or ligating wings. The force placed upon thebracket and contained wire can be controlled by changes in the size(diameter) of the O-ring, the thickness of the material, and thecomposition of the material itself. However, presently available O-ringsgenerally do not maintain a consistent force and must be periodicallyreplaced.

Clips, on the other hand, can be made from materials that will notexhibit the same decaying properties of present elastomeric materials.For example, FIGS. 14 and 15 show a disclosed system nickel-titaniumwire clip 74, interchangeable with any of the above systems. Tensioningdevices, or clips, may be configured to be either inserted into a slot72 at the base 78 of the bracket or attached to the ligating wings 76 orsuch other point of attachment added to the bracket as needed. Clips 74may be formed of any material that will create a force consistent withwhat is needed to bring the three components of the force moduletogether within the slot to draw the wire 14 and the apex together, suchas nickel-titanium or other suitable memory wire. In general, anytensioning device effective to provide a compression force to bring thethree components of the force module together within the slot may beemployed.

FIGS. 16 through 18 show a system employing a magnetic pillow-style clip82. For example, the clip 82 includes a magnet 88 for engaging anoppositely-poled magnet 80 in the base 78 of the bracket. The clip 82can include posts 84 to guide the clip 82 along the wings 76 as theattraction between magnets 80 and 88 draws the clip 82, and the wire 14,toward the base 78, as shown in FIG. 18.

The clip 82 shown in FIG. 17 includes a spring 86, such that the clip 82can be extended to reach over one pair of wings 76 during placement. Asshown in FIG. 19, a magnetic pillow-style clip 90 can be formed of anelastomeric material, so the body of the clip 90 stretches such thatposts 90 reaches beyond the pair of wings.

FIGS. 20-23 show a system with helical springs 100 secured to a base104. In this example, the spring 100 is secured to the base 104 onopposite sides with a clip 102 in between. Thus, the clip 102 spans aslot 106 through which a wire 14 extends. As shown in FIG. 21, thesprings 100 may be secured to the base 104 by one or more fasteners 108,such as posts. The springs 100 force the wire 14 toward the base 104 bycompression, until the wire 14 is seated in the apex, shown in FIG. 23.In some examples, the base is marked, scored, or otherwise treated toenhance adhesion to a surface of the teeth. As shown, the region 98 ofthe base 104 includes hatching that may hold adhesive and increase thesurface area for such adhesion, thereby facilitating a solid bondbetween bracket and tooth.

FIGS. 24-26 show a system with compression spring 112 inside a hingedcap-style clip 110. The clip 110 includes a hinge 114 that rotates abouta pin 116 to allow for placement of the wire 14 within the slot. Once inplace, the clip 110 is closed by a latch 118 situated near the base ofthe bracket. FIG. 25 shows a closed clip 110 where the spring 112 iscompressed, exerting force against wire 14 toward the base. FIG. 26shows the spring 112 expanded, forcing wire 14 to be seated in the apex.

FIGS. 27 and 28 show a system with helical compression springs 136internally positioned within the bracket wings 130. Opposing springs 136are joined by horizontal bars 124 to which the clip 120 may attach. Forexample, a tool 126 may include a manipulator 128 to engage with anopening 122 of the clip 120. In this manner, the clip 120 can be mountedbetween bars 124 after placement of the wire 14. Once in place, the wire14 is forced against sloped surface 134, as the springs 136 force thebars 124 and the attached clips 120 toward the base of the bracketguided by channels 132.

FIG. 29 shows a system illustrating a single (per side) helical springclip design. As shown, a spring 142 is fixed (e.g., by welding, brazing,integrated manufacturing, etc.) to a clip 140 (e.g., a T-bar) on one orboth sides of bracket base 150. In examples, the spring extends throughthe base 150 by a slot or void 148. On the opposite side of the base150, a post(s) 144 can secure the spring to the base, such as by a hook146, although other methods, such as adhesive, welding, soldering,tension fittings, clips, etc., are also considered based on a particularapplication. Although illustrated as resting on a generally planarsurface of base 150, in some examples the surface of the base 150 mayinclude hatching suitable to accommodate a post 144 and/or hook 146(see, e.g., FIG. 21). In some examples, channels embedded in the base150 such that, as the post(s) 144 and/or hook(s) 146 are set in place,they do not extend beyond the generally planar surface of the base 150.In some examples, the post(s) 144 are integrated with the base 150, suchthat the spring 142 can attach to the post(s) 144.

FIG. 30 shows a system illustrating a double (per side) helical springclip design. As shown, springs 154 are fixed to a clip 152 (e.g., aT-bar) on one or both sides of bracket base 150. In examples, the springextends through the base 150 by slots 158. On the opposite side of thebase 150, posts 156 secure the springs 154 to the base, such as by ahook 160. FIG. 30 can similarly include hatching, channels, and/orintegrated posts, such as described with respect to FIG. 29.

FIGS. 31 and 32 show a system illustrating helical springs 162 embeddedin the base of the bracket with an interconnecting bar 164 that willallow effective movement of a clip 166 to draw the wire 14 and thebracket base toward one another.

For lingual applications, brackets will differ in that they will bereduced in bracket height and will incorporate either a rotational armthat will close over the slot, or a sliding arm that will close over theslot from a gingival to incisal direction.

FIGS. 33-35 show a lingual system with a first style of self-ligation.For example, a clip 168 is fixed to a bracket 170 by a pin 172 or othermechanism about which the clip 168 may pivot. As such, the clip 168 maypivot over a barrier 176 to reveal the slot 174 for wire placement, andthen be returned to a central position to apply force to the wire withinthe slot.

FIGS. 36-41 show a lingual system with another style of self-ligation.As shown, bracket 180 mates with a clip 182 which is configured to slideto reveal the slot 184 for wire placement. After placement of the wire,the clip 182 slides into a void 188 within a sheath 186 to protect theclip 182 and prevent unwanted contact with the patient's tongue, etc.FIGS. 40 and 41 show an alternative clip design 190 with an inverted “Y”shape. Thus, when in place the clip 190 would apply a force at twopoints of contact with a wire that extends through slot 184 for betterrotational control.

In addition to the appliance, also disclosed is a plier for adjustmentsof the archwire to properly guide the teeth into their correct position.FIGS. 42 and 43 show a design for a plier for making adjustments of thearchwire. The plier may be designed with spacers 192 for a particularwire type (e.g., a triangular wire of one or more dimensions), andadvantageously include protractor-style markings 194 on it to allow forbetter determination of torque control of the archwire.

FIGS. 44-46 show a molar tube design 200 with a C-type clip 212 toinsure accurate labio-lingual positioning of the wire along the slope204 in the apex of the slot. As shown, the bracket 208 includes abreakaway tab 206 that may include perforations, or may be otherwisemanipulable (such as with a cutting tool, a roll-back tab, etc.) toallow for easy removal. The bracket 208 may also comprise an auxiliaryslot 210 for auxiliary attachments as needed for additional torsional orrotational movements. This or similar designs can also be utilized forimproved accuracy with the conventional appliances by using arectangular slot instead of the triangular slot.

Practitioners using conventional edgewise appliances have, since theearly 1980's, been trying to reduce the amount of adjustments in thewire needed during a treatment regime to adjust the teeth correctly. Fora conventional edgewise appliance treatment, average torsionalmeasurements, labio-lingual positions of the teeth relative to adjacentteeth, and angulation of the roots of the tooth have been included whendetermining the position of the wire receiving slot relative to the baseof the bracket or tube. Adjustments placed in each individual bracket,based on averages developed as early as 1972 by Andrews, and modified bysuch individuals as Roth and McGlothlin, Bennet and Trevisi (MBT), havebeen used to align the teeth with minimal adjustments to the archwire,assuming the brackets are placed on the teeth in highly precisepositions. However, because the wires of the conventional edgewiseappliance engage the slot of the bracket with significant tolerancebetween the wire and slot, torque control in the conventional edgewiseappliance may be expressed only as an average (see, e.g., FIG. 7).

Advantageously, the use of average tooth positions to determine thetorque, angulation and labio-lingual position of the teeth is not neededin the disclosed system. Instead, the present disclosure provides acustom designed approach, which determines the force and adjustment foreach tooth individually, and creates an application that employs agradual, continuous force during treatment. For instance, thecustom-adjusted appliance system may utilize computer assisteddiagnostic imaging (e.g., 3-dimensional cone beam scans or theequivalent), computer-aided treatment plans, custom-built individualbrackets and/or tubes configured to render results consistent with thecomputer-aided treatment plan, and laboratory-constructed indirectbonding trays with the embedded brackets placed ideally for transfer tothe patient. The customizable features of the disclosed system thereforedo not rely on average force determinations, as do conventional systems.

Practitioners employing the disclosed system may employ as few as onearchwire (e.g., a triangular wire) for the entirety of the treatment(e.g., from start to finish), depending on the initial malocclusion. Iftorsional forces cause a significant increase in the labio-lingualheight of the brackets or tubes, then robotically bent archwires couldbe constructed to work in this custom-built appliance that wouldcompensate for the lack of torque adjustment that could be reasonablyplaced in the custom brackets.

The advantages of the disclosed system over conventional systems arenumerous. For example, conventional systems (e.g., the EdgewiseAppliance) require full engagement of the archwire within the bracketslot, whereby the force applied against the bracket is concentrated, yetcan be felt by adjacent teeth, as illustrated in the example in FIG. 7.

By contrast, FIGS. 10 through 12 show spacing detail from an applicationof the presently disclosed orthodontic system on several teeth. Asshown, the disclosed system independently applies a gradual, continuousforce against each bracket, which results in movement in all threeplanes until the archwire becomes fully seated within the apex of thebracket slot.

Furthermore, unwanted and uncontrolled torsional movements on adjacentteeth, which are unavoidable in conventional edgewise appliances, areeliminated in the disclosed system because an independently workingforce module moves each tooth. Torque placed in the wire may eventuallybe fully applied at the respective bracket of the disclosed system whenthe archwire moves into the apex.

Due to the diverging line angles in the disclosed system, minimalfriction is seen in the disclosed system. Couples created by theparallel line angles within the conventional edgewise bracket slot arerequired for control of tooth movement, but introduce unavoidablebinding and friction when opening and closing spaces. Coupling thatcauses binding and friction, which is unavoidable in the conventionaledgewise system, may be eliminated. Advantageously, such coupling iseliminated in the disclosed system.

Due to the improvements of the disclosed system over conventionaldesigns, fewer or no archwire changes are needed to complete thetreatment. Thus, the disclosed system may reduce the number ofpractitioner adjustments needed to complete the treatment.

Due to lighter, continuous forces generated by the disclosed system,treatment for the patient is gentler and more comfortable. Similarly,the disclosed system may cause fewer iatrogenic problems since heavyintermittent forces are reduced or eliminated. Further, the force modulein the disclosed system acts as a built-in shock-absorbing system. Asbiting pressures are placed on each tooth the force module unit can flexand allow a more biological response to the biting forces. Such aflexible, biologically compatible movement cannot be achieved in theconventional edgewise system.

In examples, mechanical attributes of the disclosed system can providebenefits over conventional systems. For instance, teeth are movedprimarily by individual force modules rather than the force/deflectioncharacteristics of an archwire, an attribute not before realized in afixed orthodontic appliance.

Unintended movement of adjacent teeth is reduced or eliminated in thedisclosed system due to the individual tooth modules. Unintendedmovement occurs as standard procedure in all conventional edgewisesystems and is the reason anchorage values in Edgewise Appliancetreatment are so critical. For example, in conventional edgewisesystems, placing a torsional movement in the wire (i.e. twisting thewire axially) to move a single tooth will adversely move the teethadjacent to the intended tooth and is unavoidable.

Advantageously, there is gradual, continuous movement between thearchwire and the presently disclosed bracket. By contrast, the forceinteraction between the archwire and the conventional edgewise bracketis focused and rigid. Research shows that more movement occurs peradjustment in the disclosed bracket compared to the conventionaledgewise system due to the precise nature of the wire-bracket slotinteraction.

Research shows that the rate of movement in the disclosed system is moregradual and more consistent than in the conventional edgewise system.For example, friction is virtually eliminated due to the diverging lineangles of the slot design. There is no mechanism in the disclosed designto create a mechanical couple that will restrict movement along the longaxis of the wire during space opening or closing. By contrast, couplingestablished within the parallel line angles of the conventional edgewiseappliance slot are the fundamental elements of tooth control for theconventional edgewise system. Friction is necessary for conventionaledgewise orthodontics to control the positions of teeth, but is aproblem when sliding mechanics are needed for opening or closing spaceor unraveling crowded teeth.

By employing the disclosed system, quantifiable and controllable forcescan now be placed on individual teeth, if desired. For example, sincethe deflection of an archwire is not needed to move the teeth in thedisclosed system, the measurable force/deflection characteristics of thetensioning device used on each tooth can be easily and individuallycontrolled.

By contrast, the conventional edgewise system relies on a complex systemof forces that include anchorage values of individual teeth and thehighly variable force/deflection values of the archwire that isdifferent at any point on its length. Due to that variability, it hasbeen analytically impossible to calculate the force levels on anyparticular tooth within the conventional edgewise system. In effect, theorthodontist has always placed forces on the teeth by “feel” and theability of the wire to engage the wire into the slot without creating apermanent deformation of the wire.

Due to the gradual movement of the bracket apex toward the archwire, theamount of movement within the disclosed system is self-limiting. Bycontrast, other forms of fixed appliances can utilize auxiliary torquingsprings that continue to move teeth and require constant monitoring toprevent more movement than is desired.

Additionally, numerous physiological benefits are enjoyed by anorthodontic patient fitted with the presently disclosed system. Forexample, the disclosed system is designed for patient comfort andbiological compatibility. The “cycle of pain” associated with the heavy,intermittent forces placed at each appointment in the conventionaledgewise system has been replaced with light, continuous forces thatabundant research has shown to be the most biologically desirable andphysiologically compatible force for moving teeth. The disclosed systemdoes exactly that, as it is designed to provide light, continuous forcesin all three planes of space (see, e.g., FIG. 11).

The ability of the archwire to slide within the bracket slot of thedisclosed system provides a built-in shock absorption system that allowsthe periodontium to function in a more normal fashion. The periodontium(i.e. supporting structures of the teeth-bone, periodontal ligament)offers a system of support to the teeth that will adjust to thepressures placed on individual teeth or groups of teeth during function.This vital function is greatly inhibited when full-dimension rectangulararchwires are placed in the conventional edgewise system as the wire islocked into all of the brackets and interferes with the ability of theperiodontium to function properly. There is little or no verticalflexibility in the conventional edgewise system. By contrast, thedisclosed system will allow these minute flexing movements to occurwithout allowing the position of the tooth to change.

Because the disclosed system permits the teeth to function more normallyduring treatment, the practitioner may expect a reduction in the amountof iatrogenic damage to the teeth (such as, for example, underminingbone resorption and root shortening) using the disclosed system. Suchdamage is an ordinary consequence of the intermittent application ofheavy forces for long periods of time typical of using the conventionaledgewise system.

Moreover, studies have shown that the level of discomfort following anadjustment appointment is less for the disclosed system than theconventional edgewise system.

The orthodontic practitioner realizes unique benefits that stem from thepresently disclosed system and its use as well. For example, leveling,aligning and torque control of the teeth can be done with one wire inthe disclosed system. By comparison, at least three, and most often manymore, are required for use with the conventional edgewise system.Further, since each wire change requires an office visit, fewer officevisits, just for the leveling and aligning phase of treatment, will berequired for the disclosed system. This could be three to six fewerappointments required for both the office and patient to manage just inthe initial phases of treatment.

Additionally, the disclosed system is an ideal appliance for patientstraveling long distances, due to fewer appointments, continuous movementuntil all desired movement is expressed, and is self-limiting.

Brackets can be constructed of a variety of materials that are notdesigned to withstand the heavy, torsional forces the conventionaledgewise appliance frequently applies to the bracket slot. For example,transparent and/or lighter materials can be used, providing aestheticand other benefits to the patient. Moreover, bracket breakage is aproblem in conventional edgewise systems with some materials. This isnot a problem with the disclosed design since the wire does not engagethe bracket with heavy, focused forces sufficient to cause breakage,which is a common issue with the conventional edgewise appliance.

Treatment philosophy and protocol do not need to change for thepractitioners. Wire sequences can still be employed for those lookingfor a “cookbook” approach for their assistant's ease of use. In anyevent, all the attributes of the disclosed system will combine to reducechair time for the practitioner by half, or perhaps, more. The processof ligating the archwires also becomes much easier since the wire is notrequired to fully engage with the bracket slot, such that the patientdoes not experience the immediate discomfort from initial fullengagement.

Consistent with the facility with which the improved disclosed system iscreated, manufacturing techniques for such a design are similarlyimproved. For instance, the disclosed system can employ tooth imagingoptions (e.g., three-dimensional cone-beam or intra-oral scans, etc.) togenerate customizable brackets that will be produced for each toothbased on pre-determined final positions of the teeth. These custombrackets with slot positions placed in each bracket according to theirfinal position will be transferred to the doctor through indirectbonding trays produced by a dedicated lab so that accurate placement ofthe brackets can occur. Pre-formed wires may accompany the bracketplacement bonding trays and may be produced by employing robotic wirebending based on the previously mentioned imaging.

We claim:
 1. A system for moving a first tooth in a patient's mouth, thesystem comprising: a bracket having a surface configured to be mountedto a first tooth and a pair of wings defining a slot having oppositelydisposed first and second surfaces that converge at an apex, a wirerunning through the slot at a distance from the apex, and a tensioningdevice configured to provide a force pressing the first surface of theslot toward the wire; wherein the system is configured so that thetensioning device gradually moves the apex of the slot toward the wire.2. The system of claim 1, wherein the tensioning device is attached tothe bracket.
 3. The system of claim 1, wherein the tensioning devicecomprises an O-ring, a clip, a cap operatively attached to one or moresprings, or a magnetically-operated cap.
 4. The system of claim 3,wherein the bracket comprises a clip-receiving slot and the clip isinserted into the clip-receiving slot to attach the clip to the bracket.5. The system of claim 3, wherein the one or more springs are positionedin the cap, in the bracket, or both.
 6. The system of claim 1, whereinthe magnitude, direction, or both of the force pressing the firstsurface of the slot toward the wire is adjustable.
 7. The system ofclaim 1, wherein the first and second surfaces of the slot form a 55 to65-degree angle at the apex.
 8. The system of claim 7, wherein the wireis a triangular wire configured to fit in the apex.
 9. The system ofclaim 1, wherein the system is configured so that the system is capableof responding to an external pressure placed on the first tooth bychanging the magnitude, direction, or both of the force pressing thefirst surface of the slot toward the wire.
 10. The system of claim 9,configured such that an external pressure placed on the first toothhaving a certain magnitude and direction reduces the magnitude of theforce pressing the first surface of the slot toward the wire.
 11. Amethod for moving a first tooth in a patient's mouth, the methodcomprising: mounting a bracket to the first tooth, the bracketcomprising a slot having oppositely disposed first and second surfacesthat converge at an apex; placing a wire within the slot; and bringing atensioning device into contact with the wire so as to provide a forcepressing the first surface of the slot toward the wire at a distancefrom the apex, thereby imparting a force on the first tooth; wherein thetensioning device gradually moves the apex of the slot toward the wire.12. The method of claim 11, wherein the magnitude, direction, or both ofthe force on the first tooth is independent from the forces placed onadjacent teeth.
 13. The method of claim 11, wherein the wire ispositioned within the slot so that the tensioning device presses a firstportion of the wire against the first surface of the slot and a secondportion of the wire against the second surface of the slot.
 14. Themethod of claim 11, wherein the tensioning device comprises an O-ring, aclip, a cap operatively attached to one or more springs, amagnetically-operated cap, or a combination thereof.
 15. The method ofclaim 14, wherein the bracket comprises a clip-receiving slot and theclip is inserted into the clip-receiving slot to attach the clip to thebracket.
 16. The method of claim 14, wherein the one or more springs arepositioned in the cap, in the bracket, or both.
 17. The method of claim11, further comprising adjusting the amount of force by which thetensioning device presses the first surface of the slot toward the wire.18. The method of claim 17, wherein adjusting the amount of force bywhich the tensioning device presses the first surface of the slot towardthe wire comprises tuning the tensioning device.
 19. The method of claim18, wherein adjusting the magnitude, direction, or both of the force bywhich the tensioning device presses the first surface of the slot towardthe wire comprises replacing a first tensioning device with a secondtensioning device.
 20. The method of claim 11, wherein the magnitude ofthe force imparted on the first surface of the slot toward the wire isreduced in response to an external pressure placed on the first tooth.21. The method of claim 20, wherein the tensioning device temporarilymoves the apex of the slot away from the wire in response to an externalpressure placed on the first tooth.
 22. A method for independentlymoving first and second teeth, the method comprising: mounting a firstbracket on a first tooth and a second bracket on a second tooth, thefirst bracket comprising a first slot defining a first surface and thesecond bracket comprising a second slot defining a second surface;placing a wire first and second surfaces; providing a first localizedforce between the wire and the first surface, and providing a secondlocalized force between the wire and the second surface, in which thesecond force is the same as or different from the first force, therebyimparting an independent force on each of the first and second teeth.23. The method of claim 22, wherein the first localized force isprovided by a tensioning device attached to the bracket.
 24. The methodof claim 22, in which the first localized force and the second localizedforce are different in magnitude.
 25. The method of claim 24, whereinthe first localized force is provided by a first tensioning device andthe second localized force is provided by a second tensioning device.26. The method of claim 25, wherein each of the first and the secondtensioning devices comprises a clip attached to the associated bracket.27. The method of claim 25, in which the first tensioning device isdifferent from the second tensioning device.